AB1547-HPR CAN A NURSE REPLACE THE DOCTOR IN AN UNCOMPLICATED PATIENT COURSE IN A PMR CLINIC? WHAT DO THE PATIENTS SAY?
Authors: S. Højmark Jakobsen
Journal: Annals of the Rheumatic Diseases (2022)

Background Since 2020 the Rheumatology Outpatient Clinic of OUH, Svendborg Hospital has offered telephone consultations for patients diagnosed with muscular arthritis (PMR) treated with prednisolone. Since 2021 has the course for the non-complexed patients been run by nurses. Initially patients only see a rheumatologist at the time of admission and the rheumatologist is only involved again if complications occur in the course e.g. that the patient can´t reduce Prednisolone as agreed without getting symptoms. At same day the patients are diagnosed by a rheumatologist they have a conversation with the nurse. The nurse gives both oral and written information about the disease and a Prednisolone reduction schedule is handed out to the patients. Afterwards the patients are followed by nurses and by telephone contact only. The telephone contact with the patients take place after 2, 10 and 17 weeks. When the patients are down to 7.5 mg of prednisolone daily, the nurse discharge the patient in our out-patient clinic to their own GP, who then takes care of the rest of the treatment and reduction of prednisolone to zero. There are more literature reviews about PMR and outpatient clinics led by nurses and patient satisfaction, but we have not found anything about the patient satisfaction when they only have contact to nurses during their course. Objectives The aim of this qualitative study was to examine the impact on patient satisfaction when they only have contact to nurses during their course and at the same time examine whether the patients have missed talking to a rheumatologist. In addition to this, we were interested in the understanding and degree of application of the written reduction schedule. Methods All PMR patients completed in the outpatient clinic between December 2021 and January 2022 where asked to participate in a telephone interview at the end of their treatment. They were asked about their satisfaction with nurse consultations during their course on a scale from 0-10: 0= not satisfied and 10= high satisfaction. The patients were also asked if they had missed not to talk to a rheumatologist and finally they were asked about the Prednisolone reduction schedule. Results 20 patients participated in the telephone interviews. 55% of the patients responded 10 on a scale from 0-10 in satisfaction talking with the nurses. 25% responded 9 on the scale, 15% mentioned 8 on the scale and 5% mentioned 7 on the scale. All of the patients answered no regarding the need to talk with a rheumatologist. None of the 20 patients has been re-admitted to our outpatient clinic afterwards. 75% of the patients have no problem in following the Prednisolone reduction schedule and found it easy to read and understand. Conclusion With the limited number of participants, it is not possible to conclude anything definitive, but the answers indicate that the patients are satisfied with nurse consultations only during their course in the outpatient clinic and the answers also indicate that they have no need to talk to a rheumatologist. Our research could therefore indicate that nurses with a specific protocol in hand are capable of managing a course for non complex PMR patients including discharging the patients from the outpatient clinic. The answers regarding the reduction schedule reassured us, that it is understandable which should reduce the possibility of errors in the treatment. References [1]Christoffer Mørk, Mette Y Dam, Mikkel G. Callsen, Kresten K Keller. The effect of a nurse-led prednisolone tapering regimen in polymyalgia rheumatic: a retrospective cohort study. Rheumatol. Int. 2021 Mar, 41 (3): 605-610 [2]Sheena Hennell MSc, BA(HONs), RGN, Eileen Spark RGN, Barbara Wood RGN, Emmanuel George FRCP, PhD. An evaluation of nurse-led rheumatology telephone clinics. Musculoskeletal Care /Volume 3, 2006, Issue 4/ p 233-240 Acknowledgements I want to thank nurse specialist and master in healthcare Pia Toftegaard for her help and advice while writing this abstract. Disclosure of Interests None declared